Haematuria is the medical term for blood in the urine. It can be visible to the naked eye — turning the urine pink, red, or brown — or detectable only on urine dipstick testing (microscopic haematuria). Both types require investigation.
Haematuria is never normal. While the most common causes are benign (urinary tract infection, kidney stones), blood in the urine can also be the first sign of bladder cancer, kidney cancer, or other serious conditions. The NICE guideline NG12 recommends urgent investigation for all patients with unexplained visible haematuria.
| Cause | Notes |
|---|---|
| Urinary tract infection (UTI) | Most common cause in women; usually accompanied by burning or frequency |
| Kidney stones | Often associated with loin pain; blood may be visible or microscopic |
| Bladder cancer | Painless visible haematuria in adults over 45 is bladder cancer until proven otherwise |
| Kidney cancer | Often painless; may be an incidental finding on ultrasound |
| Glomerulonephritis | Inflammation of the kidney filters; often microscopic haematuria with protein |
| Enlarged prostate (BPH) | Common in men over 50; can cause haematuria with urinary symptoms |
| Trauma | After injury to the kidney, bladder, or urethra |
You should seek investigation for haematuria if:
Do not wait for a second episode. A single episode of visible haematuria in an adult over 45 meets the NICE criteria for an urgent two-week-wait referral for suspected bladder cancer. A private ultrasound at Sonoworld can provide a same-day assessment while you await NHS investigation, or can be used as a standalone investigation if your GP has not referred you.
A kidneys, ureters and bladder (KUB) ultrasound scan is the appropriate first-line investigation. It visualises the kidneys, bladder, and urinary tract and can identify kidney stones, renal masses, bladder wall thickening, and other structural causes of haematuria.
Ultrasound does not visualise the urethra or the inside of the bladder as well as cystoscopy, so a normal ultrasound does not exclude bladder cancer. If you have visible haematuria and are over 45, you should also be referred for cystoscopy regardless of the ultrasound result.
We regularly see patients who have had one episode of visible haematuria, been told by their GP that it was probably a UTI, treated with antibiotics, and discharged without imaging. When they come to us — often weeks or months later after a second episode — the ultrasound identifies a structural cause that should have been investigated at the first presentation. The NICE guideline is clear: visible haematuria in an adult over 45 requires urgent investigation, not watchful waiting.
Not always — the most common causes are UTI and kidney stones, both of which are treatable. However, haematuria can also be the first sign of bladder or kidney cancer, which is why all episodes require investigation rather than watchful waiting.
Yes. A single episode of visible haematuria in an adult over 45 meets the NICE criteria for urgent investigation. Do not wait for a second episode.
No. A urine dipstick or culture can identify infection but cannot visualise the kidneys, bladder, or urinary tract. An ultrasound scan is needed to identify structural causes of haematuria.
Sonoworld is registered with the Care Quality Commission (CQC). Our sonographers are registered with HCPC and are members of BMUS. All scans are performed at our Marylebone clinic: 29 Weymouth Street, London W1G 7DB.
Same-day and next-day appointments available at our Marylebone clinic. Instant verbal results. Written report within 24 hours. No GP referral required.
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